Patients with a prior malignancy face a higher risk of early mortality after a heart transplant (HT), according to a new study published in Circulation: Heart Failure.
The prevalence of pretransplant malignancy (PTM) has increased dramatically over the past two decades, leading researchers to examine why the benefits of HT in patients with PTM should be balanced against the risks of post-transplant malignancy.
"The development of targeted therapeutic agents including immunotherapies has significantly improved patient outcomes and lowered recurrence rates for both solid and hematologic malignancies,” wrote lead author Jaya Batra, MD, a cardiologist at Columbia University College of Physicians and Surgeons in New York City, and colleagues. "The purpose of the current study was to evaluate trends, patient characteristics, and post-transplant outcomes for recipients of HT with PTM in the era of contemporary oncological therapeutics."
Over the past two decades, the authors noted, the percentage of patients with PTM receiving a HT increased from 3.2% in 2000 to 8.2% in 2020.
Meanwhile, the number of transplant centers transplanting patients with PTM increased from 31.1% in 2000 to 71.3% in 2020.
The group's study included data from more than 27,000 HT patients. Of that cohort, 7.7% had a history of PTM.
Data was extrapolated from United Network for Organ Sharing registry. All HT patients were treated from January 2010 to December 2020.
Overall, the presence of PTM was linked with higher unadjusted rates of one-year mortality (11.9% vs. 9.2%) and five-year malignancy (20.4% vs. 13.1%) following a HT.
“The findings of this study raise two important questions,” the authors wrote. “To what extent transplantation should be restricted in patients with PTM, especially given the increased risk for mortality associated with prior hematologic malignancies; and whether immunosuppression protocols should be individualized for patients with PTM, particularly in the context of lower rates of early graft failure and late cardiovascular deaths in the hematologic PTM group observed in this analysis.”
Read the full study here.